肝胆管结石术后复发的危险因素预测及十二味疏肝利胆颗粒的防治观察  

Prediction of Risk Factors for Postoperative Recurrence of Hepatobiliary Stones and Observation on the Treatment of 12-ingredient Shugan Lidan Granules

作　　者：朱承宇 彭辉 张琦[2,3] 齐伟 黄龙 张万宗[3] 胡高斌 于庆生 ZHU Chengyu;PENG Hui;ZHANG Qi;QI Wei;HUANG Long;ZHANG Wanzong;HU Gaobin;YU Qingsheng(The First Clinical Medical College of Anhui University of Traditional Chinese Medicine,Anhui Hefei 230031,China;The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine,Anhui Hefei 230031,China;Institute of Surgery,Anhui Academy of Chinese Medicine,Anhui Hefei 230031,China)

机构地区：[1]安徽中医药大学第一临床医学院,安徽合肥230031 [2]安徽中医药大学第一附属医院,安徽合肥230031 [3]安徽省中医药科学院外科研究所,安徽合肥230031

出　　处：《中医药临床杂志》2025年第2期369-374,共6页Clinical Journal of Traditional Chinese Medicine

基　　金：十二五国家临床重点专科建设项目(财社[2013]239号);十二五国家中医药管理局重点专科建设项目(国中医药医政发[2012]2号)。

摘　　要：目的:分析肝胆管结石术后复发危险因素,观察十二味疏肝利胆颗粒对复发危险因素的治疗效果。方法:回顾性分析133例肝胆管结石手术患者病例资料,选择81例分析术后复发危险因素,其中复发组13人,未复发组68人;64例观察十二味疏肝利胆冲剂疗效,其中观察组33例,对照组31例。应用多因素logistic回归分析肝胆管结石术后复发相关危险因素;并针对危险因素(肝功能、胆汁生化、细菌培养)观察十二味疏肝利胆颗粒的临床疗效。结果:①术后结石复发的危险因素分析:病毒性肝炎、间接胆红素升高、胆汁培养阳性是结石复发的独立危险因素。②针对危险因素十二味疏肝利胆颗粒的疗效:术后第14天观察组ALT、AST、TB、UCB水平均明显低于对照组(P<0.01);术后14天胆汁培养阳性率观察组(12.12%)明显低于对照组(35.48%)(P<0.05);术后12个月进行随访,观察组结石复发率明显低于对照组(9.09%vs29.03%,P<0.05)。结论:病毒性肝炎、间接胆红素升高、胆汁培养阳性是结石复发的独立危险因素,十二味疏肝利胆颗粒能够针对性改善胆红素代谢和胆道感染,有效预防肝胆管结石复发。Objective To analyze the risk factors of recurrence after hepatobiliary stones and observe the therapeutic effect of 12-ingredient Shugan Lidan Granules on recurrence risk factors.Methods For retrospective analysis of 133 patients,81 patients were selected for postoperative recurrence risk factors,including 13 in the recurrence group and 68 in the unrecurrence group;64 patients observed the efficacy of 12-ingredient Shugan Lidan Granules,including 33 in the observation group and 31 in the control group.Multivariate logistic regression was used to analyze risk factors related to postoperative recurrence of hepatobiliary stones and observe the clinical efficacy of the risk factors(liver function,bile biochemistry and bacterial culture).Results(1)Analysis of risk factors for postoperative stone recurrence:viral hepatitis,indirect bilirubin elevation,and positive bile culture were independent risk factors for stone recurrence.(2)The efficacy of gallbladder granules for risk factors:ALT,AST,TB T,and UCB were significantly lower in the observation group than the control group(P<0.01);the observation rate of positive bile culture at 14 days(12.12%)was significantly lower than the control group(35.48%)(P<0.05);after 12 months,the stone recurrence rate was significantly lower than the control group(9.09%vs29.03%,P<0.05).Conclusion Viral hepatitis,indirect bilirubin elevation and positive bile culture are independent risk factors for stone recurrence.12-ingredient Shugan Lidan Granules can improve bilirubin metabolism and biliary tract infection,and effectively prevent the recurrence of hepatobiliary stones.

关 键 词：肝胆管结石 复发危险因素 十二味疏肝利胆颗粒 

分 类 号：R269[医药卫生—中西医结合]